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T215 M41L
Jan 10, 2008

I am treatment nave and have recently had a Susceptibility test and tested positive for the M41L and T215 mutations. The only NRTI with full susceptibility is FTC and 3TC which I understand cannot be used together.

I understand that this has limited my options for first line treatment and I am seriously concerned about my future treatment options.

Are there any promising new NRTIs in development that could be used in the future to construct an acceptable 2xNRTI & 1x NNRTI regime?

Response from Dr. Sherer

Though your initial treatment options have been limited, the extent of the limitation is mild at worst, and you and your doctor still have many viable options for initial therapy.

The M41L and the T215 mutations are thymidine analogue mutations or TAMS, and they do reduce the potential benefit of AZT (Retrovir) and D4T (Stavudine), and, to a lesser extent, ABC (Ziagen). Nonetheless, these drugs would still have some residual activity against your virus.

You could still be treated with the most popular current initial regimen, i.e. atripla, which is efavirenz (Sustiva) + tenofovir (Viread) + emtricitabine (FTC or Emtriva). SImilarly, you could be treated with that NRTI backbone plus a boosted PI such as lopinavir or atazanavir.

There are some next generation NRTIs in development, but they are still a long way away from approval. These include fosalvudine, a next generation thymidine; Racivir, which is a cousin of 3TC; and apricitabine, which is a cytidine analogue with activity against virus with TAMS and the M184V mutation.

I urge you to talk to your doctor about your concerns and these resposes to your questions.


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